Stabilization of Volar Ulnar Rim Fractures of the Distal Radius: Current Techniques and Review of the Literature

Abstract

Background?Distal radius fractures involving the lunate facet can be challenging to manage. Reports have shown the volar carpal subluxation/dislocation that can occur if the facet is not appropriately stabilized. Literature Review?Recent emphasis in the literature has underscored the difficulty in managing this fracture fragment, suggesting standard volar plates may not be able to adequately stabilize the fragment. This article reviews the current literature with a special emphasis on fixation with a specifically designed fragment-specific hook plate to secure the lunate facet. Case Description?An extended flexor carpi radialis volar approach was made which allows access to the distal volar ulnar fracture fragment. Once provisionally stabilized with Kirschner wire fixation, a volar hook plate was applied to capture this fragment. Additional fracture stabilization was used as deemed necessary to stabilize the remaining distal radius fracture. Clinical Relevance?The volar marginal rim fragment remains a challenge in distal radius fracture management. Use of a hook plate to address the volar ulnar corner allows for stable fixation without loss of reduction at intermediate-term follow-up.

Plate coverage predicts failure for volarly unstable distal radius fractures with volar lunate facet fragments

“…Nowadays, several fixation options have been described for volarlly unstable distal radius fractures with a small VLF to prevent loss of reduction after operative fixation, and they include a distally placed volar locking plate, a volar rim plate, fragment-specific fixation (wire form or hook plate), or the use of supplemental fixation methods such as sutures, pinning, or external fixation [4,[7][8][9][10][11][12][13][14][15][16][17][18]. These alternative fixation methods such as a distally placed volar locking plate, a volar rim plate (A) (B) Figure 2.…”

“…Loss of reduction after operative fixation of volarly unstable distal radius fractures with a volar lunate facet fragment (VLF) is considered problematic because it results in carpal subluxation or dislocation and subsequent impaired function, pain, limitation of range of motion, and posttraumatic arthritis [ 1 , 2 ]. Previous studies have reported that the incidence of failure of fixation is 4–13% [ 2 – 4 ]. Several factors have been reported to contribute to this.…”

Palmar approach with Kirschner-wire fixation in the treatment of children's distal radius extension type fracture

“…With regard to the choice between palmar and dorsal surgical approaches, there are no standard guidelines. Palmar approach has become more and more popular in adults, 9 , 10 , 11 because it is more beneficial for wrist function recovery than the dorsal approach. 12 For children, the majority of distal radius fractures are caused by falling on their palms with forearm in pronation and wrist in extension position and result in forward-angulated fractures and extension-type fractures.…”

Assessment and Management of Acute Volar Rim Fractures

“…The smaller dimensions of these implants can facilitate accurate placement to capture a specific fragment, but these are insufficient by themselves, and must be used in conjunction with other implants. Reports have shown satisfactory outcomes, and while tendon irritation was reported with early versions of this plate, 31 more recent reports with lower profile devices have shown these complications to be less prevalent. 32 Chin and Jupiter first described a wire loop fixation technique for treatment of intra-articular fragmentation in distal radius fractures.…”